If you are in the physical medicine field this title probably stopped you in your tracks. If you know me personally you probably grabbed the arms of your office chair and are currently holding your breath. With all the inflammatory information flying around the internet, comparing comparable professionals is a dangerous task.
To make my message as clear as possible I want to provide a little disclaimer. I am a Physical Therapist. I understand Physical Therapy incredibly well. There is a wide variety of specific practices that both physical therapists and chiropractors take and therefore this blog will not cover 100% what every single PT can/might do with someone vs. what every single chiropractor can/might do. Instead, I am seeking to provide consumers a basic understanding of what they are getting when they walk into a given physical medicine practitioners office.
Let us imagine that it is the late 90's. Clothing styles are loose fitting and terribly uncomfortable, society is becoming more connected than ever with the introduction of the cell phone and the internet is in full swing. We can look up just about anything on a whim and within 2-3 minutes have the answer we want in a context that means something to us. But occasionally our thick, square, gray desktop computer gets a little angry. The fan kicks on, everything slows down, and all of a sudden this block of a machine becomes more of a pain in the ass than a tool for information gathering. So, what do we do? We take it to the UBreak IFix store around the corner or the RadioShack down the street.
Let's say you decide to go to the UBreak IFix store.
The gentleman behind the counter (the Chiropractor) says to you "Ah yes I see this problem all the time with this model. The (insert computer brand of choice) is prone to this sort of problem and I can fix it in 2 seconds." (To be clear, your body is the computer, the fan noise is the pain).
So the chiropractor opens up the task manager, scrolls through until he sees one of the tasks running at 90% CPU and closes it down. Ahhhh, the fan slows down and stops. He then clicks exit on all the error messages and voila, the computer is calm again. He then closes down a few more of the programs that were frozen and says, “Ok great. The problem is taken care of. Now we are going to open a couple browsers you don’t use very often, make sure they aren’t becoming dormant and causing issues with the system.” (This program refreshing is the exercise equivalent of glutes and abs exercise).
You then go through a couple programs together, everything looks (feels) good and you pay the man before he says “Like I said earlier, this problem is common for computers like yours. You should expect to need to come back every 4-6 weeks to make sure the computer is running optimally. If it’s not, it’s better to get ahead of the issue.” And you think to yourself "Well that makes perfect sense. Of course I don’t want to let my computer freeze in the middle of an online scrabble match. I’ll be back in 4 weeks for another computer adjustment." 4 weeks go by, you notice the computer starting to slow, so you head back into the UBreak IFix store and see your buddy the Chiropractor and he closes down the programs that are running up the CPU usage and everything settles back down.
If you bring that same problem into a RadioShack (Physical Therapist's office) they would tell you that you are running too many programs at once. They would start the same as the Chiropractor, opening up the task manager and closing out the biggest CPU hog and then say "Your processor isn’t built for this speed, if you want to run all those programs at once, we can work on building you a faster processor, but it takes some time." If you really want to run excel, word, aol (lol) and MySpace (lolol) all at once then you need to build up your processors tolerance for all that activity. If this level of activity interests you, you would say "Sure! I’d love to be able to run them all at once. Let’s work on it!" And you would bring your computer back once or twice a week for 4-8 weeks until the processor adapts to the tasks you like to do and can handle them without the fan kicking on overdrive and ruining your activity. Each session that you bring your computer in, the RadioShack gentleman examines the computer, identifies which programs are continuing to run slow and back up the system, and devises an updated program to address it. He also gives you a list of programs to close out each night to ensure you aren’t clogging up the system in the meantime and asks that you open up MySpace and Aol at least once each day to keep their processing programs fresh. You come back each week with signs of the same problem but each week they improve. At the end of the 6 weeks you are running all your programs together, the computer fan is always quiet but working normally, no error messages pop up unless you try something crazy and new. Life is good!
These two metaphors explain that chiropractors seek to modify the current input (spinal tension pattern), adjust it, and then back it up by exercising muscles not commonly used to make sure things can ramp up and ramp down. This is a very neurologic process (turning muscles on, then letting them relax) but there also benefits to the exercise in regards to the strengthening aspect. If you use a lot of programs, you won’t lose them. This approach is great for many people.
The physical therapist metaphor seeks to explain that your body has a tolerance for tasks. What might seem like a simple task such as a search for your best friend on MySpace (or sitting at your desk doing excel spreadsheets) actually causes significant strain on your processor. Remember, the processor is your brain, and the fan blowing hard is the pain. You hear the fan (the pain), you can’t run your Myspace (perform your tasks), but the correlation to MySpace and the fan is not always 100% clear. Even though the RadioShack attendant can see the CPU usage is raised way above normal when you search on Myspace, they don’t know exactly why the usage is so high either. They only see what they can test for (aka the task manager), and then make a plan to improve the processors ability to manage tasks (clean up unnecessary program usage and practice opening and closing the programs that are desired, aka exercise) because this eventually leads the processor to recognize these patterns and become more efficient in performing them (efficiency is fluidity). This approach is great for many people too.
This explanation is extremely basic, and certainly there is more to it for both services, but the underlying message is the true. Chiropractors seek to down-regulate a pain response with a neurologic intervention such as an adjustment, then have their clients perform rudimentary exercise. Physical Therapists seek to understand what movement patterns cause pain, then balance these patterns out and build resilience for desired activities over time.
When deciding if you are right for Chiropractor services or PT services you need to ask yourself one question. Do I want a quick, temporary fix or do I want a program to follow that will eliminate the cause of my problems and improve my capability over the long term.
Our parents and many self help books would lead us to believe that wanting instant gratification is a negative trait reserved for drug addicts and adulterers. The truth is, we all want some instant gratification! Especially when we are in pain! It’s not weak or inappropriate, it is natural. However, (here comes my bias) our human system, brain and body, has an incredible ability to control our situation, and the perception of our situation. If you haven’t heard about the statistics regarding disc bulges and herniations in people with absolutely no symptoms please perform a google scholar search. If your goal is simply to get out of pain fast, listen to the Airrosti ads and get your tight muscles released, get your back adjusted and go back to living life. If you want to understand why muscles get tight, why you are in pain and how to fix it for the long term, seek a qualified physical therapist.
I will add a delayed disclaimer. There are good and bad chiropractors as well as good and bad PT's. Just because you’ve been to see one does not mean you understand what the full capability that either service has to offer. For physical therapy, hour long one-on-one sessions are the gold standard. If you were treated by an unlicensed technician, treated for 20-30 minutes by a PT, or spent most of your time in a pool, you did not receive a high level of care.
Why does it matter?
To bring it back to the metaphor, the computer (your body) is a complex system. It has an incredible amount of simultaneous processes all running at once to produce what you see on the screen (movement patterns). If your practitioner's exposure to whats on the screen (the faulty movement pattern) began when they got the job at RadioShack, but they never studied computer programming, their ability to solve computer problems will be limited. This is why technician treatments are not optimal. Does it mean it will never work? No, it works all the time. Especially if you just had an orthopedic surgeon open up your screen and put everything back in the right spot with new wires.
Now many of you may be thinking, PT sounds a lot like working out. I already do that. Or, I already do that, with a trainer. What can PT offer that I shouldn't already be getting from my normal activity. I exercise daily, I get coached and I still have pain.
Well let me tell ya!
As a physical therapist, I was offered exposure to the NASA researchers of computers (the smartest people in physical medicine). NASA and Stephen Hawking (The Postural Restoration Institute and Ron Hruska) have exposed me to the deep underlying reflexive movement patterns that all humans employ to maneuver throughout daily life. Posture is often misunderstood as being the way we hold our spine, shoulders and head during daily activity. In reality, posture is the neuro-muscular strategy we employ to keep our physical structure oriented in space. (If you couldn't tell, this blog is about to get weird).
Posture begins at our rib cage and pelvis. The way our muscles move and maintain position of these structures during all the activities we do throughout the day decides what distribution of internal pressure we experience. For instance, if you slouch aggressively in your chair, you place increased pressure at the front of your intervertebral discs pushing back against the spinal cord. It's pretty awesome that your spine is an absolute UNIT when it comes to absorbing pressure, otherwise this might be an issue. However, if your neuro-muscular pattern of postural control lacks variability (you can't ever stop slouching) then that pressure might become an issue. Any sustained posture or pattern can be irritating for our systems, just have someone hold their finger lightly against your back and wait, in 5 minutes you are going to want to yank their hand off.
If your an athlete who has trained themselves to handle intense challenges for postural control (picking up heavy shit off the ground, pulling your heavy body up toward a bar, pushing heavy loads off your chest etc) but your neuro-muscular patterns lack variability, you will likely experience pain. You need to limit variability to perform a skill, but increase variability to not overuse a particular strategy and irritate the tissues. What does a big truck with no brakes do?
Pressure, we use it to lift heavy stuff with a firm inhale. What if your distribution of this pressure is asymmetrical (as all humans are). What if your pressure distribution asymmetry orients your hip, spine, shoulders, neck, knees, and ankles into positions that are not optimal for handling load? Answer: you've got problems my friend.
Let's stop there for now....
When seeking out services, do your homework. Your doctor may know a place to go, but likely doesn’t know who they are sending you too. Reach out, get the consultation, find out what your committing to and then commit.